A soldier is seen in this file photo on the third floor at Walter Reed Army Medical Center in Washington, which closed last year. / Luis Alvarez, AP

by Gregg Zoroya, USA TODAY

by Gregg Zoroya, USA TODAY

The Walter Reed scandal of 2007 launched a raft of reform within the Pentagon, but much of that initiative has since dried up, according to a government study released today.

While new programs still assist 20,000 wounded, ill or injured military outpatients through their medical care each year, others languish in the system's bureaucracy, researchers with the Government Accountability Office found.

"The momentum (to improve the care system) has waned over time," says Randall Williamson, the senior investigator on the case.

Williamson says they found individual service members who had fallen through gaps in care, but records were incomplete for ascertaining whole numbers.

A GAO report published earlier this week estimated that some 94,000 service members left the military between 2009 and 2011 sick enough to be receiving psychiatric or pain medications.

The report today says troops with so-called "invisible" wounds of the wars, such as post-traumatic stress disorder or traumatic brain injury, are particularly at risk of not receiving the coordinated care and management they need.

"After five years, recovering service members and veterans are still facing problems as they navigate the recovery care continuum, including access to some of the programs designed to assist them," the study says.

Media reports in 2007, led by the Washington Post, which later won a Pulitzer Prize for its work, uncovered case management deficiencies and agonizing delays for outpatients at then-Walter Reed Army Medical Center. Congress investigated and worried whether the nation could keep pace with its combat casualties.

Reforms followed with service branches and the special forces creating "wounded warrior" procedures to monitor, treat and guide ailing service members through their military medical process and beyond. The Department of Veterans Affairs also assigned case managers to the most severely hurt patients.

The programs helped ailing troops, the GAO found, but problems that developed over time:

Referrals to the programs remained "imprecise," relying on inconsistent casualty reports or a commander's discretion which might be flawed.

The Pentagon began staffing oversight committees with lower-ranking officials who had neither time nor authority to implement needed changes.

The Pentagon declined to require that the services use the same criteria for allowing troops access to the resources. As a result, different branches use different criteria. For example, the Air Force limits access to only combat-related cases, where the Army includes soldiers who are injured in non-combat circumstances.

Efforts to reform the medical retirement and disability processes for troops leaving the military have only made them wait longer, sometimes more than a year.

And a decade-long effort by the VA and Defense Department to computerize medical documents remains incomplete. Federal investigators found medical personnel still printing and faxing patient files.

In a response, the Pentagon and VA agreed with much of what the GAO report says. But even as Defense officials acknowledged one key complaint - that the services handle ailing troops differently - they declined to require uniformity.

"The department agrees that the services have defined the wounded, ill, and injured populations in different ways," says a response by Dr. Jonathan Woodson, the assistant secretary of Defense for health affairs. "(But) continues to believe that the three service secretaries should control and maintain entrance criteria."

Early this year, the VA and Pentagon revamped an executive council with oversight of wounded warrior care procedures, promising improvements.

"It looks like they are putting people in those positions that can make things move again," says Williamson. "We'll see if it works. We just don't know."